Many studies since Shepherd's seminal work, Psychiatric Illness in General Practice, published almost thirty years ago, reveal that mental disorders are common in the primary care setting but that individuals with mental disturbances frequently go unrecognized with adverse consequences for patients, families, and the health care system. In the United States, Regier and colleagues have called attention to a "de facto" mental health services system comprised of the general medical services, highlighting the need for understanding how to integrate general medical care and mental health care. Primary care physicians are in an ideal position to be case-finders and coordinators for elderly persons. Often the primary care physician does not have the time or wherewithal for a complete geriatric assessment, but an effective computer-assisted assessment would substantially facilitate this process. This is particularly important because certain aspects of geriatric assessment, especially depression, are not commonly systematically addressed in primary care settings. Goals of this SBIR Phase I project are to develop, test, and implement a computer-based system for assessment of depression suitable to older adults in primary care that also will efficiently and effectively present the information to health care providers. The system will be especially designed for repeated measures, both for patients and for health care providers who will use the information. The Phase I study design has three stages. First, a prototype will be designed and tested with patients in a primary care setting. Based on this testing, the prototype will be modified. In the second stage, test-retest and validity studies will provide empirical psychometric knowledge. Finally, the experiences and perceptions of clinical staff will be systematically measured and they will be engaged in focus group discussions to learn how to improve actual implementation of the system for routine clinical use. Through the implementation of graphical display of information and standard data base functions, such a system will have flexible application for both research and clinical care in the primary care setting. Research analysis is likely to further contribute to enhancing clinical care by advancing understanding of relationships between mental and physical health and illness, increasingly important in the capitated managed health care environment. The clinical utility of the application is an important consideration from the outset of development, with goals for the early detection, treatment, and prevention of morbidity and mortality associated with depression. PROPOSED COMMERCIAL APPLICATION: Research has established the high prevalence of undetected and untreated depression in primary health care. Effective detection of depression in this setting has substantial potential to improve the quality and the economics in this sector, and thus considerable commercial potential. A smaller but significant market exists in providing inexpensive and practical computer systems for obtaining cross-sectional and longitudinal data from research subjects, e.g., epidemiologic studies.